Search Results (1,721)

Aim: To investigate the association between body mass index (BMI) and gonadotropin secretion, including serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and the LH/FSH ratio, among women with polycystic ovary syndrome (PCOS), and to compare these parameters with healthy women. Patients and Methods: This comparative cross-sectional analytical study included 400 women aged 18–35 years recruited from outpatient gynecology and endocrinology clinics at private-sector medical centers in Irbid, Jordan, between June 2025 and April 2026. The study included 200 women diagnosed with PCOS according to the Rotterdam criteria and 200 age-comparable healthy controls. The PCOS group was stratified into four BMI categories (<25, 25–<28, 28–<31, and ≥31 kg/m²), with 50 women in each category. Clinical and anthropometric characteristics were assessed, and serum LH and FSH concentrations were measured. The LH/FSH ratio was calculated for each participant. Differences between groups were evaluated using appropriate statistical tests, while one-way analysis of variance was used to compare PCOS subgroups according to BMI. Pearson’s correlation analysis was used to assess associations between BMI and gonadotropin parameters. Results: The mean age was comparable between women with PCOS and healthy controls (26.31 ± 5.36 vs. 26.47 ± 5.16 years; p = 0.23). Women with PCOS had significantly higher BMI than controls (27.85 ± 3.47 vs. 22.81 ± 2.29 kg/m²; p < 0.001). Among women with PCOS, menstrual irregularity, hirsutism, acne, infertility, and polycystic ovarian morphology were observed in 87.5%, 79.5%, 78.5%, 70.0%, and 100%, respectively. Serum LH was significantly higher in women with PCOS than in controls (8.44 ± 2.61 vs. 6.53 ± 1.16 IU/L; p < 0.001), whereas FSH was significantly lower (4.64 ± 0.98 vs. 7.96 ± 1.18 IU/L; p < 0.001), resulting in a higher LH/FSH ratio (1.84 ± 0.50 vs. 0.83 ± 0.20; p < 0.001). Within the PCOS group, LH progressively decreased across increasing BMI categories, from 11.58 ± 1.26 IU/L in women with BMI < 25 kg/m² to 5.40 ± 1.29 IU/L in those with BMI ≥ 31 kg/m² (p < 0.001). Similarly, the LH/FSH ratio decreased from 2.46 ± 0.18 to 1.28 ± 0.23 across these BMI categories (p < 0.001), whereas FSH did not differ significantly (p = 0.07). BMI showed strong inverse correlations with LH (r = −0.870, p < 0.001) and the LH/FSH ratio (r = −0.869, p < 0.001), but not with FSH (r = −0.126, p = 0.075). Conclusions: Women with PCOS demonstrated a distinct gonadotropin profile characterized by higher LH and LH/FSH ratio and lower FSH compared with healthy controls. Among women with PCOS, increasing BMI was strongly associated with lower LH concentrations and LH/FSH ratios. These findings highlight the importance of considering BMI when interpreting gonadotropin profiles in PCOS, although prospective studies are required to determine whether changes in body weight directly influence gonadotropin secretion and reproductive outcomes. Full article

Objective: Non-cavity-distorting intramural fibroids have been linked to poorer reproductive outcomes in assisted reproduction, yet strategies to counteract this effect remain underexplored. This study examined whether a hyaluronan-enriched transfer medium (EmbryoGlue^®) is associated with clinical pregnancy and live birth in women with such fibroids undergoing frozen-thawed single blastocyst transfer, and whether any such association depends on fibroid size. Methods: We conducted a single-center retrospective cohort analysis of 515 women, aged 20–37 years, carrying the International Federation of Gynecology and Obstetrics (FIGO) type 3–5 non-cavity-distorting intramural fibroids, who underwent frozen-thawed single blastocyst transfer between January 2021 and December 2025. Of these, 232 received a hyaluronan-enriched transfer medium and 283 received a standard medium. Clinical pregnancy served as the primary endpoint; positive pregnancy test, live birth, and early pregnancy loss were secondary endpoints. Multivariable logistic regression was used to identify independent predictors of clinical pregnancy and live birth and to test for an interaction between EmbryoGlue use and fibroid size. Results: Women who received EmbryoGlue had higher rates of positive pregnancy test (50.0% vs. 32.9%; p < 0.001), clinical pregnancy (40.5% vs. 26.9%; p = 0.001), and live birth (30.2% vs. 19.1%; p = 0.003) than those in the control group. After adjustment, and taking a fibroid size of 3 cm as the reference point, EmbryoGlue use remained associated with greater odds of clinical pregnancy (adjusted odds ratio [aOR] 2.05, 95% CI 1.20–3.50; p = 0.008). A significant interaction between EmbryoGlue use and fibroid size emerged for both clinical pregnancy (aOR 1.74, 95% CI 1.13–2.68; p = 0.011) and live birth (aOR 1.68, 95% CI 1.06–2.67; p = 0.028): the association between EmbryoGlue and reproductive outcomes was not uniform but depended on fibroid size, with the widest gap between groups seen among women with fibroids exceeding 4 cm. Conclusions: Among women with non-cavity-distorting intramural fibroids undergoing frozen-thawed single blastocyst transfer, EmbryoGlue use was linked to more favorable reproductive outcomes overall, an association that varied by fibroid size and was most pronounced above 4 cm. These findings warrant confirmation through prospective randomized trials before influencing clinical practice. Full article

Background/Objectives: Musculoskeletal pain is a common condition that negatively affects quality of life and functional capacity. Integrative nursing emphasizes patient-centered and non-pharmacological approaches; however, variability in clinical decision-making persists due to reliance on clinician experience. This study aimed to design, retrospectively train, and evaluate the preliminary feasibility of a machine learning-based clinical decision support framework for personalized pain management within an integrative nursing approach in a Traditional and Complementary Medicine setting. Methods: This study included a retrospective cohort of 487 patients (mean age: 48.2 ± 14.7 years; 63.0% women) for machine learning model development and evaluation. The classification model predicted binary clinical improvement, defined as a ≥3-point reduction in VAS pain score, whereas the regression model predicted post-treatment VAS score. The resulting models were incorporated into the GETAIA prototype to generate modality-specific predicted post-treatment VAS scores and probabilities of clinically meaningful improvement for the three available T&CM modalities; these predicted profiles were compared to provide a model-derived treatment recommendation for clinical review. In addition, a prospective, non-randomized pilot involving 42 patients (21 AI-assisted and 21 standard care) was conducted to assess preliminary point-of-care workflow feasibility. Results: Significant reductions in pain intensity were observed across all treatment groups (p < 0.001). Clinically meaningful improvement rates were 76.2% for cupping therapy, 68.3% for acupuncture, and 58.8% for mesotherapy (p = 0.007). The prototype demonstrated 78.3% concordance with historical clinician treatment decisions, which was interpreted as an internal model-fidelity measure reflecting the reproduction of historical clinical decision patterns rather than evidence of improved decision-making, clinical effectiveness, or external validity. During a preliminary prospective feasibility implementation, clinically favorable numerical trends were observed in the AI-assisted group compared with standard care, including clinically meaningful improvement in 85.7% (18/21) versus 71.4% (15/21) of patients (p = 0.449) and mean VAS reductions of 3.9 ± 1.2 versus 3.2 ± 1.4 (p = 0.092). These exploratory differences were not statistically significant and were not intended to establish comparative clinical effectiveness. On the held-out test set, the primary XGBoost classification model achieved an accuracy of 82.6% and an AUC-ROC of 0.87 (95% CI: 0.82–0.92), while the regression model predicting post-treatment VAS achieved an MAE of 0.87. Key predictors of improvement included diagnosis, baseline pain intensity, and age. Conclusions: The findings support the preliminary development and evaluation of a machine learning-based decision-support framework and GETAIA prototype for individualized pain management within an integrative nursing context. The retrospective analysis demonstrated predictive performance of the evaluated models, while the small, non-randomized prospective pilot provided preliminary information on point-of-care workflow integration. These findings do not establish the clinical effectiveness, superiority, routine-care readiness, or external validity of a fully implemented clinical decision support system. Larger, prospective, multicenter studies are required to evaluate clinical effectiveness, generalizability, usability, and implementation readiness. Full article

Despite major advances in cardiovascular medicine, ischemic heart disease (IHD) in women remains underrecognized and undertreated. A substantial proportion of symptomatic women have no flow-limiting epicardial stenosis, and ischemia may arise from coronary microvascular dysfunction, vasospasm, diffuse atherosclerosis, plaque-related mechanisms, spontaneous coronary artery dissection (SCAD), or combinations of these processes. Female-specific biological factors—including hormonal transitions, vascular aging, inflammation, metabolic changes, and reproductive cardiovascular risk enhancers—modify the coronary substrate across the life course. This review integrates these determinants with contemporary coronary phenotyping and proposes a clinically oriented, mechanism-based framework for IHD in women. Multimodality imaging, invasive coronary functional testing, and intracoronary imaging are considered complementary tools for identifying predominant and coexisting mechanisms. Management should combine guideline-directed cardiovascular prevention with mechanism-targeted antianginal therapy and women-specific considerations, including reproductive planning, pregnancy counseling, medication safety, and psychosocial care. This framework is intended as a practical synthesis rather than a validated classification system and aims to support more precise diagnosis and individualized treatment of women with ischemic symptoms. Full article

Background/Objectives: Polyendocrine Metabolic Ovarian Syndrome (PMOS) is a common endocrine disorder affecting women of reproductive age. Current international evidence-based guidelines promote lifestyle management, including diet and nutrition, as first-line treatment strategies. Accredited nutrition professionals, such as dietitians, are therefore well placed to deliver such support. We aimed to investigate the barriers, facilitators and practice patterns of accredited dietetic professionals in the management of PMOS. Methods: This was a mixed-methods, cross-sectional analysis of Australian dietitians using a self-administered online survey to collect: self-rated knowledge and confidence levels for PMOS care; perceived barriers and facilitators to clinical management; awareness and implementation of evidence-based guidelines; and current dietary management practices. Quantitative and qualitative data were analyzed in parallel, using both descriptive statistics and conventional content analysis. Results: Dietitians (n = 86) reported moderate levels of knowledge (n = 33; 38.4%) and confidence (n = 31; 36.5%). Perceived practice barriers included supporting women through weight management, lack of interprofessional collaboration and dietary misinformation. Facilitators to clinical management included the availability of evidence-based dietary approaches, professional development opportunities and clinical knowledge and experience. Manipulation of macronutrients, dietary patterns, individualized medical nutrition therapy and lifestyle and eating behaviors were identified as key dietary management approaches. Conclusions: Moderate levels of knowledge and confidence were observed. However, ongoing barriers, including supporting women through weight management strategies, limited interprofessional collaboration and dietary misinformation, continue to contribute to inconsistent practice patterns. Our findings highlight the need for structured professional development and improved implementation of evidence-based PMOS guidelines in dietetic practice. Full article

Adenomyosis and uterine fibroids are among the most common benign uterine disorders in women of reproductive age and represent major causes of abnormal uterine bleeding, pelvic pain, and infertility. Despite their distinct histopathological features, they frequently coexist and share several hormonal and molecular mechanisms, making diagnosis and treatment challenging. This narrative review examines the current evidence on their epidemiology, pathophysiology, clinical presentation, imaging characteristics, reproductive impact, and therapeutic management, with particular attention to the role of imaging in the differential diagnosis and management of coexisting disease. A non-systematic narrative review of the literature was conducted using PubMed/MEDLINE and Scopus. Relevant original studies, systematic reviews, meta-analyses, consensus statements, and clinical guidelines addressing adenomyosis, uterine fibroids, imaging, fertility, and treatment were considered. Additional references were identified through manual screening of the bibliographies of the retrieved articles. Although adenomyosis and uterine fibroids differ in their biological origin and morphological appearance, they commonly present with overlapping symptoms, including heavy menstrual bleeding, dysmenorrhea, chronic pelvic pain, and reproductive dysfunction. Transvaginal ultrasound remains the first-line imaging modality, whereas magnetic resonance imaging is particularly valuable in complex cases, lesion characterization, and preoperative assessment. Accurate imaging phenotyping may help distinguish isolated from coexisting disease and support individualized medical, surgical, or minimally invasive treatment planning. A structured imaging-based approach integrated with clinical findings and reproductive goals may improve disease characterization and support individualized management of adenomyosis and uterine fibroids. Further standardization of imaging criteria and validation of emerging diagnostic technologies may improve patient stratification and treatment selection. Full article

Background: Cerebral endometriosis is an exceptionally rare manifestation of extrapelvic endometriosis and remains a diagnostic challenge because its clinical and imaging features may mimic more common neurological, inflammatory, vascular, or neoplastic disorders. Catamenial neurological symptoms may provide an important diagnostic clue, but histological confirmation is rarely available. Case presentation: We report the case of a 48-year-old woman with epilepsy beginning at 41 years of age, associated with short-term memory loss and a catamenial pattern of seizures. She had no typical symptoms of pelvic endometriosis, including dysmenorrhea, dyspareunia, or cyclic pelvic pain. Neuropsychological test for memory had normal scores. Brain magnetic resonance imaging (MRI) revealed a right hippocampal lesion with T2/FLAIR hyperintensity and later pseudonodular contrast enhancement, raising suspicion of focal cortical dysplasia, infection, tumor infiltration, or a hippocampal tumor. Magnetic resonance spectroscopy (MRS) was inconclusive and did not provide clear support for tumor-like infiltration. Because of the temporal association between symptoms and menstruation, cerebral endometriosis was considered. The patient received hormonal therapy with progestins, including desogestrel and dienogest, after which antiepileptic therapy was discontinued. Neurological symptoms resolved completely. Follow-up MRI demonstrated marked regression or disappearance of the previously described right hippocampal hyperintense lesion, with preserved bilateral hippocampal morphology. Conclusions: This case highlights the importance of considering cerebral endometriosis in women of reproductive or perimenopausal age presenting with catamenial epilepsy and unexplained intracranial lesions, even in the absence of pelvic endometriosis symptoms. Recognition of menstrual cyclicity, careful neuroimaging follow-up, and multidisciplinary evaluation may support diagnosis and guide individualized treatment. The favorable clinical and radiological response to progestin therapy in this case adds to the limited evidence regarding conservative management of presumed cerebral endometriosis. Cerebral endometriosis is a very rare condition, and only eight case reports were found in the literature. Full article

Background: Alcohol consumption is common among women and men of reproductive age. The effects of alcohol use in the preconception and early-pregnancy periods on early reproductive outcomes are not well-known. Methods: In a population-based cohort study from preconception onwards among 3225 women and their partners, we examined the associations of preconception and early-pregnancy alcohol consumption, assessed by questionnaires, with fecundability (per-cycle probability of conceiving), infertility (time to pregnancy >12 months or use of assisted reproductive technology), and miscarriage (pregnancy loss before 22 weeks of gestation). Results: As compared to no alcohol consumption, preconception intake of <1 glass/week and ≥1 glass/week among women was associated with lower odds of infertility (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.39, 0.94 and OR 0.54, 95% CI 0.35, 0.84, respectively). As compared to no alcohol consumption, early-pregnancy alcohol consumption among women of <1 glass/week and ≥1 glass/week was associated with increased odds of miscarriage (OR 1.99, 95% CI 1.36, 2.92 and OR 2.37, 95%CI 1.58, 3.57). Early-pregnancy binge drinking among women was also associated with increased odds of miscarriage (OR 1.52, 95%CI 1.04, 2.24). Alcohol consumption among men was not associated with infertility or miscarriage risk. Conclusions: The associations of low-to-moderate preconception alcohol consumption with lower odds of infertility might reflect healthier lifestyles, socioeconomic factors, and residual confounding by health-related abstinence from alcohol, all of which are associated with greater fertility. Therefore, preconception and early-pregnancy counseling should mainly focus on the risk of miscarriage and fetal health outcomes. Full article

Obesity affects nearly one in three women of reproductive age worldwide and consistently reduces success rates in in vitro fertilization, yet the molecular basis for this reduction remains fragmented across separate lines of evidence. Circadian clock genes, particularly BMAL1, orchestrate metabolic and reproductive physiology through transcription–translation feedback loops present in adipose tissue, ovarian granulosa cells, and endometrial stroma. Adiposity-driven metabolic shifts, including altered PPAR-γ signaling and reduced glutamine–methionine uptake, degrade BMAL1 expression and flatten its rhythmic oscillation in peripheral tissues. Within granulosa cells, loss of BMAL1 rhythmicity impairs mitochondrial biogenesis and disrupts UPRmt-mediated proteostasis, driving reactive oxygen species accumulation and compromising oocyte competence. Parallel disruption of clock-controlled transcription factors in endometrial epithelium and stroma is proposed to alter decidualization programs and displace the window of implantation, which would produce a receptivity defect independent of oocyte quality if confirmed directly in human tissue. Clinical data are consistent with a dual mechanism: obese women undergoing donor-oocyte cycles—where oocyte quality is controlled for—show reduced implantation rates in several but not all cohorts—a pattern compatible with an endometrial contribution distinct from oocyte-level damage, rather than proof of it. Synthesizing evidence from adipocyte biology, ovarian physiology, and endometrial receptivity research drawn largely from rodent models, cultured cell systems, and observational human cohorts, this review proposes BMAL1 dysregulation as a candidate unifying mechanism connecting obesity to impaired IVF outcomes at the gametic and uterine level, while acknowledging that direct causal evidence in humans is still lacking. Chronotherapeutic strategies, including melatonin supplementation and the timing of weight-loss interventions relative to ovarian stimulation, are discussed as hypotheses for future testing rather than current clinical recommendations. BMAL1 dysregulation is presented here as one candidate contributor among several interacting mechanisms, and any translational strategy would need to be part of a broader, coordinated approach to obesity-related IVF failure rather than a stand-alone intervention. Full article

Background/Objectives: Schistosomiasis affects about 250 million people globally, including an estimated 40 million women of reproductive age and over 10 million pregnant women each year. Praziquantel is a key component of schistosomiasis control and is recommended by the World Health Organization (WHO) for use during pregnancy; nevertheless, its use is uneven due to ongoing safety concerns. Methods: This narrative review synthesizes evidence from randomized controlled trials (with the strongest evidence for the second and third trimesters), observational studies (including limited first-trimester exposures), pharmacokinetic analyses, case series, and WHO policy documents published between 1980 and March 2026. Results: Across all major Schistosoma species, praziquantel demonstrates high efficacy in pregnancy, with cure rates comparable to those in non-pregnant populations. No increased risk of miscarriage, stillbirth, congenital anomalies, preterm birth, or low birth weight has been observed in randomized controlled trials (RCTs) or cohort studies. Treatment of S. haematobium improves maternal anemia and may confer benefits on neonatal iron status and immune development; evidence gaps remain regarding first-trimester exposures and long-term offspring outcomes. Conclusions: Aligning national policies with WHO guidance and integrating praziquantel into antenatal care could substantially reduce maternal morbidity and improve neonatal health. Full article

Background: Endometriosis affects approximately 6–10% of women of reproductive age—an estimate that varies substantially with the diagnostic standard applied—and is increasingly recognized as a systemic inflammatory disease. Growing evidence implicates shared immunological pathways between endometriosis and autoimmune thyroid disease, yet large-scale real-world evidence from standardized multi-site data remains limited. We evaluated the association between endometriosis and newly recorded autoimmune thyroid disease using federated Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) data from 12 Korean hospitals. Methods: We conducted a propensity score (PS)-matched cohort study using OMOP-CDM version 5.3 data from 12 Korean tertiary academic medical centers. Women aged 18–60 years with a first recorded endometriosis diagnosis were matched 1:1 to controls without endometriosis on age, calendar year, hypertension, and selected Charlson comorbidity index components. Site-specific Cox proportional hazards models, fitted to patient-level records locally at each institution, estimated hazard ratios (HRs) for newly recorded autoimmune thyroid disease, defined as Hashimoto’s thyroiditis or Graves’ disease. Pooled estimates were derived using DerSimonian–Laird random-effects meta-analysis; leave-one-out meta-analysis, meta-regression on site-specific follow-up ratio, and an E-value were used to assess robustness. Results: After 1:1 PS matching, 71,619 women with endometriosis and 71,619 matched controls were included. Mean follow-up was 2693 days in the endometriosis group and 1677 days in the control group. A directionally positive but statistically inconclusive association was observed between endometriosis and autoimmune thyroid disease (pooled HR 1.22, 95% CI 0.97–1.53; p = 0.090; I² = 38.2%). Seven of twelve sites reported HRs above 1.0, including two sites reaching individual statistical significance: AUMC (HR 1.38, p = 0.030) and KHUH (HR 2.69, p < 0.001). The pooled HR remained above 1.0 in all 12 leave-one-out iterations (range 1.17–1.31); omission of KHUH reduced I² to 6.6%. Site-specific follow-up imbalance was not associated with the site-specific log HR (meta-regression p = 0.887). The E-value for the point estimate was 1.74. Conclusions: In this multi-site OMOP-CDM analysis, endometriosis showed a directionally positive but statistically inconclusive association with newly recorded autoimmune thyroid disease. The confidence interval is compatible with both no association and a clinically meaningful increase in risk, and the findings are hypothesis-generating rather than confirmatory. They do not support any change in the clinical evaluation of women with endometriosis. Further validation is warranted using standardized outcome definitions, thyroid autoantibody measurements, and thyroid function tests. Full article

Background: Evidence regarding long-term outcomes among offspring following maternal or paternal exposure to BCR::ABL1 tyrosine kinase inhibitors (TKIs) is limited. We described pregnancy outcomes and offspring health through adolescence and early adulthood in a single-centre cohort of patients with chronic myeloid leukemia (CML). Methods: This retrospective, descriptive cohort study included patients with chronic-phase CML who experienced a pregnancy, or whose partner experienced a pregnancy, in association with TKI exposure and for whom longitudinal offspring follow-up was available. Long-term offspring outcomes were ascertained from detailed obstetric and pediatric medical records supplemented by parental reports. Fourteen patients (nine women and five men) contributed 21 pregnancy events and 23 live-born offspring, including two twin pregnancies in the paternal-exposure group. Results: In the maternal-exposure group, median gestational age at delivery was 38.0 weeks (range, 35–40), and four of 15 deliveries were preterm. In the paternal-exposure group, median gestational age was 39.0 weeks (range, 38–41), with no preterm deliveries. Median offspring follow-up was 252 months (range, 212–295), extending through adolescence and into early adulthood. One offspring had a primum atrial septal defect that was surgically corrected. No additional clinically documented major abnormalities in growth or developmental progress were identified during available follow-up. Given the small cohort, these observations were interpreted descriptively and were not considered evidence of equivalence with population-level rates. Conclusions: This small retrospective cohort provides unusually long observational follow-up of offspring after selected maternal or paternal TKI exposures. The findings are clinically informative but cannot establish reproductive safety or exclude rare adverse outcomes. Larger multicentre registries using standardized long-term developmental, neurocognitive, and endocrine assessments are needed. Full article

Background and Objectives: Despite long-standing MMR vaccination programmes, outbreaks of vaccine-preventable diseases continue to occur worldwide, raising concerns regarding waning immunity and susceptibility gaps in adult populations. Between 2017 and 2019 alone, WHO reported over 880,000 measles cases globally—a fourfold increase over the preceding two years—with outbreaks in both low- and high-income countries despite high childhood vaccination coverage. This study evaluated the seroepidemiology of measles, mumps, and rubella among adults in Türkiye over a nine-year period. Materials and Methods: A retrospective laboratory-based study was conducted using ELISA IgM and IgG results obtained between 2014 and 2022 at a tertiary-care university hospital. Seropositivity rates were analysed by year, age group, and sex. Temporal trends were assessed using the Cochran–Armitage trend test; factors associated with IgG seropositivity were assessed using multivariable logistic regression. Results: Among 10,407 adult test records, overall IgG seropositivity was 75.8% for measles, 94.9% for rubella, and 86.3% for mumps; IgM positivity remained low throughout (0.9%, 0.4%, and 1.9%, respectively). Measles IgG declined significantly from 78.4% in 2014–2019 to 62.6% in 2022 (p < 0.001), whereas Rubella IgG remained stable (93.2–95.7%) and Mumps IgG showed no significant temporal change. Seropositivity increased markedly with age for measles (18–29 years: 70.2% vs. ≥50 years: 93.4%; p < 0.001) and mumps (p = 0.030). Multivariable analysis confirmed that Measles IgG seropositivity was substantially lower in 2022 than in the pooled 2014–2019 period (OR = 0.432, 95% CI: 0.319–0.584, p < 0.001). Rubella seroprotection among women of reproductive age was 94.7% (95% CI: 93.9–95.5%), close to but not statistically distinguishable from the 95% population immunity benchmark used in rubella elimination frameworks. Conclusions: A significant measles immunity gap exists among younger adults in Türkiye, with Measles IgG seropositivity declining from 78.4% in 2014–2019 to 62.6% in 2022, consistent with a cohort effect whereby vaccine-era cohorts exhibit lower protection than older adults with naturally acquired immunity. Rubella immunity, by contrast, remained close to the 95% elimination benchmark throughout. These findings underscore the importance of targeted serological surveillance and evidence-based booster vaccination strategies. Full article

Background: Women with chronic medical conditions are at increased risk of adverse pregnancy outcomes, making contraceptive counselling an essential component of comprehensive chronic disease management. However, evidence regarding the knowledge and clinical practices of non-obstetric physicians remains limited. This study evaluated physicians’ knowledge, attitudes, and practices regarding contraceptive counselling for women with chronic medical conditions in a tertiary referral hospital in Türkiye. Methods: A cross-sectional Knowledge–Attitude–Practice survey was conducted among 264 non-obstetric physicians at İzmir City Hospital between July and October 2025. The questionnaire assessed contraceptive counselling practices, awareness of the World Health Organization Medical Eligibility Criteria for Contraceptive Use (WHO MEC), postgraduate contraception training, perceived barriers, and educational needs. Categorical associations were examined using chi-square or exact procedures as appropriate, and multivariable binary logistic regression was performed to evaluate factors associated with self-reported routine contraceptive counselling while accounting for potential confounding. Results: Among the 260 physicians who responded to the relevant item, 89.2% agreed that contraceptive method selection may influence the course of chronic disease, whereas 37.9% of the total sample reported routinely providing contraceptive counselling. Awareness of the WHO MEC was limited, with 75.8% reporting no prior awareness, and 18.2% had received postgraduate contraception training. In the adjusted analysis, WHO MEC awareness (aOR = 2.76, 95% CI: 1.39–5.46; p = 0.004), postgraduate contraception training (aOR = 2.38, 95% CI: 1.12–5.07; p = 0.024), seeing ≥30 women of reproductive age per week (aOR = 2.07, 95% CI: 1.15–3.73; p = 0.016), female sex (aOR = 3.81, 95% CI: 1.90–7.65; p < 0.001), and >10 years of clinical practice (aOR = 2.38, 95% CI: 1.23–4.62; p = 0.010) were associated with higher odds of self-reported routine counselling. Specialty was not significantly associated after adjustment. Conclusions: Self-reported routine contraceptive counselling remained limited despite broad recognition of the relevance of contraception in chronic disease care. Guideline awareness, postgraduate training, clinical exposure, sex, and clinical experience were associated with routine counselling after adjustment, although causal relationships cannot be inferred from this cross-sectional study. These findings support further evaluation of educational and organizational strategies for integrating reproductive healthcare into chronic disease management. Full article

Endometriosis is a chronic estrogen-dependent systemic inflammatory disorder characterized by ectopic implantation of endometrial-like tissue, primarily on the ovaries, pelvic peritoneum, and bowel. According to the World Health Organization (WHO) estimate updated in 2025, endometriosis affects approximately 10% (about 190 million) of reproductive-age women worldwide and is a major contributor to chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Standard medical therapies focus on ovarian suppression, which alleviates symptoms but precludes conception and carries significant metabolic and skeletal adverse effects. Recent multi-omics research has raised interest in the gut microbiome and the estrobolome, defined as the microbial gene repertoire involved in estrogen metabolism, as potential modulators of systemic estrogen exposure and immune homeostasis. Altered microbiota composition and microbial β-glucuronidase activity may influence enterohepatic estrogen recirculation; however, endometriosis-specific evidence is predominantly associative or preclinical and does not establish a causal pathway. Dysbiosis and increased bacterial β-glucuronidase activity promote enterohepatic recirculation of estrogens, contributing to hyperestrogenism and ectopic lesion proliferation. Concurrently, oxidative stress, peritoneal inflammation, aberrant macrophage polarization, and neoangiogenesis sustain lesion survival and contribute to chronic pelvic pain. This comprehensive review synthesizes mechanistic, preclinical, and clinical evidence regarding microbiome-targeted interventions and nutritional compounds, including probiotics, prebiotics, N-acetyl cysteine (NAC), curcumin, resveratrol, epigallocatechin gallate (EGCG), omega-3 polyunsaturated fatty acids (PUFAs), and vitamin D, in modulating the estrobolome, immune responses, and oxidative microenvironment in endometriosis. We further discuss dietary patterns, bioavailability challenges, and the potential of precision nutrition to optimize reproductive outcomes. These approaches may be considered complementary or investigational adjuncts; current evidence is insufficient to demonstrate disease modification or improvements in spontaneous pregnancy, assisted reproductive technology (ART) outcomes, or live birth. Here, “fertility-sparing” denotes the absence of intentional ovulation suppression rather than proven fertility enhancement. Full article